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**Key Method Used Key O=Observation; T=Post-test; V=Verbalization; D=Demonstration; R=Document review; S= Simulated Testing Station/Lab; Other-define
Form Revised July 2008
Employee’s Name ______
NORTHSHORE UNIVERSITY HEALTHSYSTEM
DEPARTMENT ORIENTATION CHECKLIST
FOR THE NEW OR TRANSFERRED EMPLOYEE
Employee Name Hire Date
Position Dept. NameSupervisor
Corporate orientation completed on
To: Managers/Supervisors
This checklist provides an outline for you to follow in welcoming and introducing the new employee to his/her position, department, and to NorthShore.
- The Joint Commission (JCAHO)requires that Environment of Care items be covered before the employee begins the activities of his/her position. Complete the balance of the checklist within 30 days of hire or transfer as indicated.
- Those whose employees have regular clinical patient contact should also develop, update and complete an initial competency assessment of new employees by using a Department/Job Orientation checklist specifically designed for their area. This combined with the corporate checklist will provide the initial job training and information to assess staff’s ability to fulfill their responsibilities, and will serve as evidence of compliance with the Joint Commission, federal, state and regulatory standards.
- Indicate each item “Reviewed” with initials and date, or if an item is “Not Applicable.”
- Indicate the method used. (**Key: see below)
- Provide a copy of the completed checklist to the employee and put the original in the employee’s department file.
By the end of the employee’s first day:
Environment of Care (Safety) / Reviewed(Initials/Date) / Method used** / N/A
Department infection control procedures and manual
Incident report procedures:
-Employee Occupational Injury/Illness Reporting
-Patient/Visitor Event Reporting
-Property Damage
-Actions to eliminate, minimize or report safety risks
Life Safety: Department fire plan/notification - response
Location of emergency alarms, exits, and fire extinguishers
Other emergency procedures: evacuation, hazardous spill, etc
Security/Access control/Sensitive areas/Workplace violence
NorthShore safety and emergency preparedness manuals and appropriate response procedures
Medical Equipment-Failures and SMDA (Safe Medical Device Act)
Utilities Management Program/Electrical
Confined space entry procedures (as applicable)
Lockout/tag out procedure (as applicable)
Hazardous substances (record of training):
-Location of MSDS’s for workplace chemicals
-Specific physical/health hazards of chemicals in work area (specify)
-Operations/conditions on job where hazardous exposures may occur
- Methods for detecting escape of hazardous chemicals into work area/uncontrolled release response
-Use of personal protective equipment, including location (specify)
-Department labeling system and corresponding MSDS
Hazards associated with non-routine tasks
Other safety policies/procedures specific to department and position (please specify):
By the end of the employee’s first week:
Department Information / Reviewed(Initials/Date) / Method used** / N/A
Department’s function and responsibilities
Departmental organizational structure, including lines of authority up to the department’s administrator
Staff introductions, including identification of key resource person(s)
Department operating manuals
Customer service expectations, including NorthShore Service Values and Department Service Plan (Be sure to discuss theNorthShoreService Values)
HIPAA/Confidentiality policies and procedures specific to job and department: patient and employee information, medical records, confidential information by phone or fax, etc.
Key department rules: discuss purpose of rules, especially relative to the delivery of good patient care:
-Call-ins for unscheduled absence and tardiness; attendance expectations
-Corporate attendance policy
-Personal Appearance policy, including identification requirement
-Rules relating to patient rights and patient abuse
Department communications, including location of department bulletin boards
Telephone: equipment and lines specific to department, paging system, voicemail if applicable; proper way to answer the phone, phone standards
Facility tour: department layout and location of other departments with whom employee will interact
Forensic Policy & Procedure (if applicable)
Information Specific to Employee / Reviewed
(Initials/Date) / Method used** / N/A
Work assignment(s) for the first two weeks
Work schedule and staffing requirements
Job description and performance expectations (provide copy of the NorthShore Job Description/Performance Appraisal form specific to the position)
Initial Competency Assessment Checklist completed (for jobs with regular clinical patient contact)
Corporate Purchasing and Accounts Payable Policies (completion of purchase orders, check requisitions, etc.) See Pulse for workshop schedule if appropriate.
Introductory Performance (90-day) Review to be completed within two weeks of:
______(date of three month anniversary)
Parking
Corporate HR Policies and Procedures / Reviewed
(Initials/Date) / Method used** / N/A
Process for recording time (e.g., swiping procedure, location of Kronos clock)
Shift differential, overtime, on-call, if applicable
Meal periods and rest periods; when, how long, where
How to change personal information in NorthShore records (e.g., address, phone number)
Other / Reviewed
(Initials/Date) / Method used** / N/A
Location of key areas: employee/visitor dining room, restrooms, lockers, elevators, stairs, etc.
Mailroom/Copy service
NorthShore No Smoking Policy
Resources for interpretive services
Disaster Plan
If applicable, skills training scheduled:
-CPR (specify date) ______
-Patient Movement (specify date) ______
-Patient Abuse (specify date) ______
-Patient Restraint Training (specify date) ______
-Patient Safety/Error Reduction (specify date) ______
-Other (specify) ______(specify date) ______
By the end of the employee’s second week:
Required Online Modules Completed(Manager verified) / Reviewed
(Initials/Date) / Method used** / N/A
Health and Safety, Infection Control, Restraints: completed online required content
Initiate Initial Competency Assessment Checklist in accordance with the Joint Commission (JCAHO) Guidelines (for jobs with regular clinical patient contact)
By the end of the employee’s first month:
Department Information / Reviewed(Initials/Date) / Method used** / N/A
Scheduling vacation and holiday time
- General (not key) department policies and procedures not previously covered; please specify:
-______
-______
Department-specific performance improvement:
-Current performance measures/indicators (provide a copy of the applicable PRC Patient Loyalty survey or other measures)
-Current performance improvement initiatives
-The employee’s involvement in performance improvement activities
General Training and Continuing Education:
-Department policy regarding attendance at training/CEU programs
-Department policy regarding reimbursement for Continuing Education costs
Volunteer Services
Corporate communication resources (Pulse, Inside NorthShore, etc.)
HR Policies and Procedures / Reviewed
(Initials/Date) / Method used** / N/A
NorthShore Performance Management policy and procedure :
-Use of the NorthShoreJob Description/Performance Appraisal form
-Merit increase procedure
-Reward and recognition
Review first paycheck stub with employee
Other (specify)
SIGNATURES AND COMMENTS
Employee acknowledgement:
I have completed the Corporate Department Orientation Checklist Form for new employees. I acknowledge that the items that are checked in the first column have been reviewed with me. I am aware of my job responsibilities, and performance and customer service expectations. I am aware that the corporate and department policies and procedures are established to promote quality patient care, excellent customer service, and to assure the health, safety and confidentiality of patients and staff. I agree to comply with the policies and procedures of the department and the organization.
Employee SignatureDate______
Supervisor’s Signature Date______
We welcome your comments on the usefulness of this Department OrientationChecklist for both the employee and supervisor. Please forward your suggestions or comments to Learning and Development, Human Resources, 4901 Searle Parkway-Skokie.
NOTE:Upon completion, provide a copy of this form to the employee and return the original completed form to the employee’s department personnel file.
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**Key Method Used Key O=Observation; T=Post-test; V=Verbalization; D=Demonstration; R=Document review; S= Simulated Testing Station/Lab; Other-define
Form Revised July 2008